title: Microlithiasis, endoscopic ultrasound, and children: not just little gallstones in little adults.
abstract: OBJECTIVE
  Biliary microlithiasis is an uncommon but recognized cause of upper abdominal pain, cholecystitis, cholangitis, and pancreatitis in adults. Gallstones smaller than 3 mm may not be seen on transabdominal ultrasound and may only be seen on endoscopic ultrasound. This condition is poorly described in children. The aim of this study is to review the results of laparoscopic cholecystectomy to treat biliary microlithiasis in a pediatric case series.
  
  
  METHODS
  We performed a retrospective case review of children with biliary microlithiasis who were treated with laparoscopic cholecystectomy.
  
  
  RESULTS
  Three children were diagnosed with biliary microlithiasis. Two patients had recurrent right upper quadrant pain and nausea. A third patient had midepigastric pain and idiopathic pancreatitis. All 3 had a normal gallbladder on transabdominal ultrasound. Additional imaging with hepatobiliary scan, computed tomography, and magnetic resonance cholangiopancreatography revealed no biliary source for symptoms. Endoscopic ultrasound was performed on all 3 children, demonstrating microlithiasis of the gallbladder. Each child had a laparoscopic cholecystectomy with intraoperative cholangiogram. No abnormalities were seen on intraoperative cholangiogram. All 3 children had alleviation of pain and improvement of symptoms in postoperative follow-up.
  
  
  CONCLUSIONS
  Children with biliary microlithiasis and associated clinical symptoms can be successfully treated with laparoscopic cholecystectomy. Endoscopic ultrasound should be considered in the evaluation of the child with clinical biliary symptoms and a negative transabdominal ultrasound result.
authors.affiliation: Department of General Surgery, Wake Forest University, Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Lucas P
authors.initials: LP
authors.lastname: Neff
authors.forename: Girish
authors.initials: G
authors.lastname: Mishra
authors.forename: John E
authors.initials: JE
authors.lastname: Fortunato
authors.forename: Jennifer
authors.initials: J
authors.lastname: Laudadio
authors.forename: John K
authors.initials: JK
authors.lastname: Petty
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D002443:Ceftriaxone / Q000009:adverse effects; D002648:Child; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002758:Cholangiography; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D003131:Combined Modality Therapy; D015897:Comorbidity; D019160:Endosonography; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000139:chemically induced; D015641:Radiography, Interventional; D012189:Retrospective Studies; D019780:Technetium Tc 99m Lidofenin; D014057:Tomography, X-Ray Computed; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D019780:Technetium Tc 99m Lidofenin; D014580:Ursodeoxycholic Acid; D002443:Ceftriaxone